Table 3 Studies by author, year title, study design and main result

Huddleston, T., Bilgili, O., Joki, A., & Vankova, Z. (2015). Migrant Integration Policy Index 2015. http://www.mipex.eu/new-zealand

To assess, compare and improve integration policy

Literature review of national data on eight policy areas: labour market mobility, family reunion, education, political participation, long-term residence, access to nationality, anti-discrimination and health.

Qualitative

1. Health services are well-prepared and responsive to the needs of diverse set of patients. Diagnostic and treatment methods are adapted to respond to specific cultural needs though mostly focused on Pacific Peoples and Māori. Cultural case workers are only available at a few specialised organisations. Free interpretation services are provided in dozens of languages through various methods.

Ministry of Business Innovation and Employment. (2019). Building and keeping a health workforce. Wellington: New Zealand Government. Retrieved from https://www.immigration.govt.nz/about-us/media-centre/newsletters/settlement-actionz/actionz3/building-and-keeping-a-health-workforce

To explore migration and health work force issues in the Western Pasific Region

Not mentioned

2. The building and keeping of a health workforce in New Zealand is in line with filling gaps of an elderly population.

Fouche, C., Henrickson, M., Poindexter, C. C., Scott, K., Brown, D. B., & Horsford, C. (2011). 'Standing in the Fire’: Experiences of HIV positive Black African migrants in New Zealand. Auckland, New Zealand. Retrieved from http://hdl.handle.net/2292/7362

To explore the lived experiences and social service needs of affected or at-risk Black African migrants, refugees and their family members in New Zealand

In-depth interviews with 13 HIV-positive Black African individuals

Qualitative

1 HIV-related stigma affects participants’ access to care for HIV treatment.

3. Lack of HIV-related education provided to health professionals who live and work with this population outside the offices of the HIV specialty providers.

Came, H. (2012). Institutional Racism and the Dynamics of Privilege in Public Health (Doctoral thesis). University of Waikato, Hamilton, New Zealand. Retrieved from https://hdl.handle.net/10289/6397

To examine the extent and how is institutional racism and Pākehā privilege manifested within public health policy and funding practices.

Counter storytelling of 10 participants, a desktop review of Crown documents, an historical analysis, co-funding field notes, literature review, a survey of public health providers and a quantitative funding analysis.

A mixed method approach.

There is institutional racism and structural inequality that determines:

1. Access and care processes for ethnic minorities;

2. Contractual practises of non-European workforce;

4. Funding allocation.

Auckland District Health Board. (2010). Youth Health Improvement Plan Youth Health Improvement Plan 2010-2014. Enhancing health and well-being for young people in Auckland District Health Board. Wellington. Retrieved from http://www.adhb.health.nz/assets/Documents/About-Us/Planning-documents/Youth-Health-Plan-2010.pdf

To improve the health status of young people living in Auckland city.

Literature review;

Interviews (youth focus groups and stakeholders).

Qualitative

1. Young people do not have equal access to services;

2. Workforce development is a key issue. There is a knowledge deficit amongst workforce trained to work with young people;

3. Information needs to be shared and coordination improved through a case management approach;

4. Projects lack funding for a coordination component.

Dumont, J., & Lafortune, G. (2017). Health Employment and Economic Growth: An Evidence Base. In J. Buchan, I. S. Dhillon, & J. Campbell (Eds.), International migration of doctors and nurses to OECD countries: recent trends and policy implications. Retrieved from https://www.who.int/hrh/resources/WHO-HLC-Report_web.pdf?ua=1

To examine trends in the international migration of health workers to Organisation for Economic Co-operation and Development (OECD) countries since 2000.

Examination of recent trends in the international migration of health workers to OECD countries since 2000 against the background of changes in migration and health policies, as well as changing economic and institutional circumstances.

Literature review.

1. Health professionals are primarily from OECD countries like intra-European Economic Area, trans-Tasman and North American. In the African Region, immigrant doctors in OECD countries came primarily from Nigeria and South Africa and were mostly expatriates.

Dumont, J., & Zurn, P. (2007). Immigrant Health Workers in OECD Countries in the Broader Context of Highly Skilled Migration. In International Migration Outlook (pp. 161-229). Retrieved from https://www.oecd.org/migration/mig/41515701.pdf

To present a comprehensive and relevant picture of immigrants in the health sector in OECD countries, in order to better inform the policy dialogue at national and international levels.

Analysis of descriptive statistics provided on migrant health workers from origin and destination country to address lack of evidence on international migration of highly skilled health workers to OECD countries.

Literature review

2. Recognition of foreign qualifications remains an important tool to insure high standards and quality in healthcare delivery, but also serves sometimes to control inflows of foreign-trained workers in OECD countries.

Health Central. (2018). Overseas doctors frustrated they can’t relieve GP shortage. Retrieved from https://healthcentral.nz/overseas-doctors-frustrated-they-cant-relieve-gp-shortage/

To explore the hurdle to being able to practice in New Zealand

Consultation with overseas-trained doctors and Medical Council. Analysis of Medical Council’s statistics.

Qualitative

2. New Zealand has an acute shortage of medical doctors but resist to change policies that enable overseas medically doctors who reside in New Zealand to practice

Kanengoni, B., Andajani-Sutjahjo, S., & Holroyd, E. (2018). Setting the stage: reviewing current knowledge on the health of New Zealand immigrants—an integrative review. PeerJ, 6(e5184). doi:https://doi.org/10.7717/peerj.5184

To examine immigrant health in New Zealand

Integrative review of 28 articles on peer reviewed research articles on immigrant health in NZ.

2. Provision of health services to ethnic minorities by migrant health professionals with awareness, empathy and positive attitudes improve accessibility to health services.

Minister of Health. (2018). Vote Health. The appropriation estimates of 2018/19 (Vol. 6): Ministry of Health. http://planetmaori.com/Files/Content/2019/est18-v6-health.pdf

Not mentioned

Not mentioned

4. One off funding of NZD48, 000.00 was done by previous government on stock take of New Zealand health system for migrant in the year 2017/18. No budget was set for 2018/19 to 2021/22.

International Migration Outlook. (2015). Changing patterns in the international migration of doctors and nurses to OECD countries. In. International Migration Outlook, Retrieved from https://www.oecd-ilibrary.org/docserver/migr_outlook-2015-6-en.pdf?expires=1554798690&id=id&accname=ocid41012844&checksum=BD8BA8B9B6026AF4F00ED0C84B01DC0C. https://doi.org/10.1787/migr_outlook-2015-6-en.

To examine how the international migration of health workers to OECD countries has evolved since 2000

Analysis of data on the trend of international migration of health workers to OECD countries since 2000 from 120 countries.

Literature review

2. Low recruitment of health workers from developing countries by OECD countries.

Ministry of Health. (2016). Health of the Health Workforce. Retrieved from https://www.health.govt.nz/system/files/documents/publications/health-of-health-workforce-2015-feb16_0.pdf

To synthesise information about the workforce and the environment it operates in, and from there to identify trends.

Review of multiple sources, including regulatory bodies such as: the Medical Council of New Zealand (MCNZ) and the Nursing Council of New Zealand (NCNZ); the wider Ministry of Health; DHBs and other employers; OECD1 reports; and New Zealand Census data.

Literature review

2. There are calls to strengthen the health and disability workforce by improving the recruitment, retention and distribution of health professionals. Another key objective is to strengthen the health workforce intelligence and data needed to provide high-quality support and advice on current and projected gaps in the health workforce.

Ministry of Health. (2017). Annual Data Explorer 2016/17: New Zealand Health Survey. Retrieved from https://minhealthnz.shinyapps.io/nz-health-survey-2016-17-annual-data-explorer/_w_32a5d991/#!/home

To provide a snapshot of the health of New Zealanders through the publication of key indicators on health behaviours, health status and access to health care for both adults and children.

An interactive tool for exploring New Zealand Health Survey data on eight key indicators: psychological distress; self-related health; unmet need for a GP due to cost; unfilled prescription due to cost; obesity; current smoking; past year drinking and hazardous drinking. Data is represented by sex, age, ethnic group and neighbourhood deprivation.

2. There were no publicly available or accessible data or statistics on the health determinants, health system performance and health of African migrants. Results show data for the Māori, Pacifica and Asian populations.

Ministry of Health. (2014). Annual Update of Key Results 2013/14: New Zealand Health Survey. Wellington: Ministry of Health.

To identify key issues and monitor trends of the health behaviours, health status and access to healthcare.

80% of adults (13,309 adults) and 85% of parents/caregivers (representing 4699 children).

Quantitative (survey)

1. 28% of adults and 22% of children had one or more types of unmet need for primary health care in the past 12 months. Unmet need takes various forms, including a person being unable to get an appointment at their usual medical centre within 24 hours and a person not going to a GP and/or after-hours medical centre when they had a medical problem due to cost or lack of transport. Neighbourhood deprivation is strongly linked to unmet need for primary health care. About one in three adults living in the most deprived areas (35%) had an unmet need for primary health care, compared with one in five (20%) of those living in the least deprived areas.

3. Although adults and children living in the most deprived areas report similar use of GPs over the last year to those living in the least deprived areas, they have much higher levels of unmet need for health care with cost being the main barrier. Adults and children living in the most deprived areas are more than three times as likely as those living in the least deprived areas to have not filled a prescription due to cost in the past year. These types of unmet need for health care are of particular concern where they affect people who are already in poor health.

Gray, Hilder, & Stubbe, 2012. How to use interpreters in general practice: the development of a New Zealand toolkit. Journal of Primary Health Care 4(1): 52-61

To identify the actual pattern of use of interpreters for migrants and refugees

Literature review on New Zealand’s District Health Boards’ policies on interpretation services

1. There is gross underuse of interpreters in the healthcare delivery system during access and care processes.

Mortensen, A. (2011). MELAA Report Summary. Nursing Praxis in New Zealand, 27(1).

Not mentioned.

MELAA groups face significant barriers to accessing health care including:

1. language and communication difficulties; health illiteracy in some groups;

2. A lack of cultural understanding by health service providers; and poor understanding of the New Zealand health system.

3. High cost of health care

Mortensen, A. (2011). Public health system responsiveness to refugee groups in New Zealand: Activation from the bottom up. Social Policy Journal of New Zealand (37), 1-12.

To examine the role of public health system in the integration of refugees.

A qualitative research using 28 in-depth semi-structured interviews with service providers in community, primary and secondary health care sectors, in both governmental and non-governmental agencies.

4. Specific health care settings for refugees and migrants are often poorly resourced.

Perumal, L. (2011). Health Needs Assessments for Middle East, Latin America and African people living in Auckland Region. Auckland: Auckland District Health Board. https://countiesmanukau.health.nz/assets/About-CMH/Performance-and-planning/health-status/2011-health-assessment-middle-east-latin-american-african-people-living-in-auckland.pdf

To investigate the population health trend of the Middle Eastern, Latin America and African (MELAA) in New Zealand.

Data analysis of the health and wellbeing of the MELAA group.

Quantitative study

1. There are access issues within the health delivery system to include inadequate oral health care, poor health education and promotion on sexual health, family planning and antenatal care, and late and poor engagement with secondary mental health services for Africans;

2. There is a paucity of health workers from African ethnic minority groups within the New Zealand Health system. Providers of African ethnic profiling have perspective taking and empathy that contributed to improved health;

3. The struggle to meet health information needs, in terms of both the quality of data collected and the speed and clarity to which this information is made available is often related to grouping Africans with Middle East and Latin Americans into a single category, commonly known as MELAA or under the ‘other’ category label.

Russell, E. (2018). South African GP with over 14 years' experience waits a year and a half to sit Kiwi medical exams. New Zealand Herald. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12040593

Not mentioned

Interviewers.

Qualitative study

2. Recognition of foreign qualifications remains an important tool to ensure high standards and quality in healthcare delivery. Overseas doctors wait one-and-a-half years to sit for New Zealand medical exams. The second of two exams only run three times a year and each sitting only has 28 spots available. When all exams are completed, overseas doctors wait five years for an internship and by that time their New Zealand medical certificate has expired.

Thomas, R. (2018). Foreign doctors struggling to get jobs in New Zealand. Stuff. Retrieved from https://www.stuff.co.nz/national/health/103932802/foreign-doctors-struggling-to-get-jobs-in-new-zealand

Not mentioned

Consultation with foreign doctors struggling to get jobs in New Zealand.

2. New Zealand has a “national immigration obligation” to prioritise New Zealand and Australian medical graduates for first year positions over foreign trained doctors.

Waitemata and Auckland District Health Boards. (2017). Asian, Migrant & Refugee Health Plan 2017-2019. Retrieved from http://www.waitematadhb.govt.nz/assets/Documents/health-plans/2017-19-Asian-Migrant-Refugee-Health-Plan-ADHB-WDHB-CPHAC-Final.pdf

Not mentioned.

Not mentioned.

3. Categorisation of Middle Eastern, Latin American and African in one category or as ‘other’ is problematic to inform, plan, and monitor services that target the unique needs of the ethnic groups separately.

5. Migrant health services are a priority in the Auckland Regional Settlement Strategy (Migrant and Refugee Health Action Plan) but not yet at national level.

Chin, M. H., King, P. T., Jones, R. G., Jones, B., Ameratunga, S. N., Muramatsu, N., & Derrett, S. (2018). Lessons for achieving health equity comparing Aotearoa/New Zealand and the United States. Health Policy, 122(8), 837-853. doi:https://doi.org/10.1016/j.healthpol.2018.05.001

To compare New Zealand and United State of America’s approaches to health equity to inform policy efforts

A comparison of Aotearoa/NZ and U.S approaches to health equity to inform policy efforts.

Narrative review of literature.

Implemented policies are frequently not explicit in how they address health inequities, and often do not align with evidence-based approaches known to improve equity:

1. There are barriers to access and high quality care in both countries to include low health literacy, and limited cultural competence of providers.

4. Out-of-pocket costs are significant barriers to access to care. Co-payments to general practitioners (GPs) in Aotearoa/NZ are unaffordable to some and the uninsured in the U.S. often rely on charity care.

Gooder, C. (2017). Immigration, ethnic diversity and cities: A literature review for Auckland Council. Auckland: Auckland Council. http://knowledgeauckland.org.nz/assets/publications/TR2017-008-Immigration-ethnic-diversity-and-cities-literature-review.pdf

To investigate the social impacts of immigration-driven ethnic diversity and cities

A literature review on international and national literature on the social impacts of immigration driven ethnic diversity and cities.

1. People from visible minority ethnic categories are being racialized by the dominant New Zealand European culture where whiteness are normalised in institutions and systems such as health which is often linked to poor health outcomes.

Schneider, E. C., Sarnak, D. O., Squires, D., Shah, A., & Doty, M. M. (2017). Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2017_jul_schneider_mirror_mirror_2017.pdf

To compare health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Data sources included Commonwealth Fund international surveys of patients and physicians and selected measures from OECD, WHO, and the European Observatory on Health Systems and Policies.

Literature review

1. New Zealand performs well on measures of care process (prevention, safe care, coordination, and patient engagement) and administrative efficiency, but below the 11-country average on other indicators like accessibility, equity and healthcare outcomes.

Ward, C., Lescelius, J., Jack, A., Naidu, R. M., & Weinberg, E. (2018). Meeting the needs and challenges of migrants and former refugees in the Nelson and Tasman regions. Wellington: The Centre for Applied Cross-cultural Research, Victoria University of Wellington. https://www.victoria.ac.nz/__data/assets/pdf_file/0011/1470872/NMC-needs-analysis-final-reportMay2018.pdf

To explore health needs analysis for migrants and former refugees in the Nelson and Tasman region.

Qualitative research. 120 (46 males and 74 females, aged 14-79 years) migrants and former refugees from Asia (43%) and Europe (20%), followed by South and Central America (14%) and the Pacific (11%) with smaller numbers from Africa, the Middle East, North America and Australia. Participants had resided in New Zealand from less than a year to 43 years with the overall average length of residence being 7.5 years. 27% of the participants were students, 60% were employed, and 21% of the participants self-identified as being from a refugee background.

1. Language and communication barriers was the identified theme. The theme intersected with the remaining five themes: Systems and Services (inadequate information, poor services and few interpreters); Culture and Identity (limited New Zealand cultural competencies, maintenance of traditional culture, and intergenerational cultural gaps); and Health and Well-being (access to medical care and health risks).

Came, H. (2014). Sites of institutional racism in public health policy making in New Zealand. Social Science & Medicine, 106, 214-220.

To examine how institutional racism manifests in public health policy making and funding practice.

Mixed methodology:

Document review of Ministry of Health policy documents from 1999 to 2011; a semi-structured interview, conducted with an upper echelon Crown official, to confirm operational practice.

1. Five specific sites of institutional racism were identified: majoritarian decision making, the misuse of evidence, deficiencies in both cultural competencies and consultation processes, and the impact of Crown filters. These findings suggest the failure of quality assurance systems, existing anti-racism initiatives and health sector leadership to detect and eliminate racism in health delivery system.

Harris, R., Cormack, D., Tobias, M., Yeh, L.-C., Talamaivao, N., Minster, J., & Timutimu, R. (2012). The pervasive effects of racism: Experiences of racial discrimination in New Zealand over time and associations with multiple health domains. Social Science & Medicine, 74(3), 408-415. doi:https://doi.org/10.1016/j.socscimed.2011.11.00

To investigate whether reported experience of racial discrimination in health care and in other domains was associated with cancer screening and negative health care experiences

The study uses data from the 2002/03 (n = 12,500) and 2006/07 (n = 12,488) New Zealand health surveys nationally representative population-based surveys of adults (15+ years).

1. New Zealand has shown reported experience of racial discrimination by a health professional to be higher among non-European ethnic groups with experiences of racial discrimination in different settings associated with multiple health outcomes and risk factors. There is a significant correlation between racial discrimination by healthcare providers with lower odds of preventive care.